jj3044 wrote:Is it better than letting healthcare become 33% of our GDP by the time my kids are in college? Yes, I think so.

How do you know that it's better? If you don't know that it's better (and it seems like you don't), why would you spend $1.1 trillion?

jj3044 wrote:The funny part is that I hear a lot of complaints that the bill is going to cost 1.1T. But it has the potential to save a far greater sum of money to our country than that.

It has the potential? What, in our history, leads you to believe that something the government does will save money? You are putting a lot of faith in a government that has, among other things, waived the requirements of the ACA for going on 300 different (and large) companies and that, among other things, has helped to nearly bankrupt social security, and that, among other things, has helped to make sure Medicare and Medicaid are ineffective at best.

That is correct, I don't know that it will be better. All I know is that the current system is unsustainable and WOULD have bankrupted our country. I'm pretty sure we are all in agreement there. So, I'm willing to try it. I think that there are a lot of good provisions in the bill that will help reduce the cost of healthcare in the long run. Hopefully our government made a good decision.

Which good provisions in the bill will help reduce the cost of healthcare in the long run?Are you concerned about the assignment of waivers to various large employers?Are you concerned that the individual mandate will require that people purchase health insurance with generous benefits and virtually no cost-sharing? What provisions of the ACA require that premiums and costs of insurance remain static? In other words, what's to prevent all health insurance from doubling their prices?

I'm not sure if you read my older posts, but I illustrated many provisions that should reduce costs and improve outcomes. Instead of re-hashing the same post, feel free to search for them... I don't post too often so it shouldn't be hard.

As for waivers, my understanding is that those waivers are for a limited time only. I know that one company that I work with has a waiver, but that waiver expires in 2014 when they are forced to change their benefit design. That being the case, I am not worried as everyone will be on the same playing field. See, the waiver was needed for groups that wouldn't be able to afford coverage if they immediately got rid of their old designs (with lifetime limits, etc) that helped keep the cost lower for those groups. If their weren't any waivers, those groups would have been forced to drop coverage way before the healthcare exchanges were set up. The waiver allowed those companies to keep coverage until the exchanges were ready in 2014. At least, that is my understanding.

I'm not sure what you consider "generous benefits". Can you elaborate? The policies must have a minimum amount of coverage in order to be approved, but I'm not sure if that is what you are talking about here?

The ACA actually does have provisions to eliminate arbitrary rate increases. Insurers are now forced to spend at least $0.85 from every dollar on paying claims, so their overhead is limited to 15% or less. Also, I believe the ACA sets up regulators that will approve rate increase filings. They look at the financials and decide if the filing is appropriate. I happen to live in a state that their has been a health insurance commissioner for some time doing just that, so I have seen how it works. He often denies or reduces the proposed rate increases.

jj3044 wrote:Is it better than letting healthcare become 33% of our GDP by the time my kids are in college? Yes, I think so.

How do you know that it's better? If you don't know that it's better (and it seems like you don't), why would you spend $1.1 trillion?

jj3044 wrote:The funny part is that I hear a lot of complaints that the bill is going to cost 1.1T. But it has the potential to save a far greater sum of money to our country than that.

It has the potential? What, in our history, leads you to believe that something the government does will save money? You are putting a lot of faith in a government that has, among other things, waived the requirements of the ACA for going on 300 different (and large) companies and that, among other things, has helped to nearly bankrupt social security, and that, among other things, has helped to make sure Medicare and Medicaid are ineffective at best.

That is correct, I don't know that it will be better. All I know is that the current system is unsustainable and WOULD have bankrupted our country. I'm pretty sure we are all in agreement there. So, I'm willing to try it. I think that there are a lot of good provisions in the bill that will help reduce the cost of healthcare in the long run. Hopefully our government made a good decision.

Which good provisions in the bill will help reduce the cost of healthcare in the long run?Are you concerned about the assignment of waivers to various large employers?Are you concerned that the individual mandate will require that people purchase health insurance with generous benefits and virtually no cost-sharing? What provisions of the ACA require that premiums and costs of insurance remain static? In other words, what's to prevent all health insurance from doubling their prices?

I'm not sure if you read my older posts, but I illustrated many provisions that should reduce costs and improve outcomes. Instead of re-hashing the same post, feel free to search for them... I don't post too often so it shouldn't be hard.

As for waivers, my understanding is that those waivers are for a limited time only. I know that one company that I work with has a waiver, but that waiver expires in 2014 when they are forced to change their benefit design. That being the case, I am not worried as everyone will be on the same playing field. See, the waiver was needed for groups that wouldn't be able to afford coverage if they immediately got rid of their old designs (with lifetime limits, etc) that helped keep the cost lower for those groups. If their weren't any waivers, those groups would have been forced to drop coverage way before the healthcare exchanges were set up. The waiver allowed those companies to keep coverage until the exchanges were ready in 2014. At least, that is my understanding.

I'm not sure what you consider "generous benefits". Can you elaborate? The policies must have a minimum amount of coverage in order to be approved, but I'm not sure if that is what you are talking about here?

The ACA actually does have provisions to eliminate arbitrary rate increases. Insurers are now forced to spend at least $0.85 from every dollar on paying claims, so their overhead is limited to 15% or less. Also, I believe the ACA sets up regulators that will approve rate increase filings. They look at the financials and decide if the filing is appropriate. I happen to live in a state that their has been a health insurance commissioner for some time doing just that, so I have seen how it works. He often denies or reduces the proposed rate increases.

I did a search and there are actually too many to read. I trust that you've indicated the perceived benefits of the ACA.

(1) Waivers - You do not seem concerned. After a few minutes of searching, I cannot find anything tangible that indicates the waivers are temporary. I went on two supportive websites (Mother Jones and the SEIU website) and did not find anything there either. That's not to say I don't believe you, but the administrators of the ACA are not making it very clear that these are temporary, and that seems like a rather easy way to debunk conservative critiques. Kathleen Sebelius noted that "without the waivers, many employers would have increased premiums, and some would have dropped coverage altogether." A lobbyist for the AFL-CIO noted (in defense of his organization's waiver), that "some union health plans had a legitimate need for waivers because they had annual coverage limits lower than $750,000. If they had to increase coverage to that level they would incur significant new costs." These two statements seem to indicate that the ACA should not be implemented for all employees; just those employees of organizations which could afford the increased limits. That seems rather counterintuitive.

(2) Generous benefits - A simple example might be appropriate. Prior to the ACA, a health insurance plan cost $100 and provided potentially $200 of benefits. Subsequent to the ACA, a health insurance plan cost $120 and provided potential $500 of benefits. Does it concern you that the increase in benefits is not offset by an increase in cost?

(3) Rate increases - The law does not prevent rate increases. From the "healthcare.gov" website:

"For the first time ever in every State, insurance companies must publicly justify any rate increase of 10% or more. And the law gives States new resources to review and block these premium hikes."

I'm not sure how "public justification" of a rate increase helps. There can be a request or demand for public justification without a law. I make a demand for justification for price increases when I choose to purchase a cheaper pair of shoes. The market tends to take care of these things. Nevermind that the threshhold is 10% or more. This also seems like burden shifting by the government. Instead of the federal government assuming the burden of blocking premium hikes, it puts the onus on state governments. And, although some may call me paranoid, I'm not convinced that insurance companies don't have the wherewithal or political capital to block and attempts at blocking premium increases... especially at a state level.

I'm not suggesting that the ACA is a bad law. I don't know the answer. There are things about it that concern me (in addition to those listed above). To be honest, I would have preferred a state-run healthcare program than the ACA (although my most preferred plan would be to remove health insurance regulations completely and provide for increased competition). To be fair, as well, the ACA is essentially the Republican plan from the late 1990s and was implemented by a Republican governor in Massachusetts. Ultimately my concern is that this is a corporate boondoggle for health insurance companies that will merely pass more costs on to taxpayers. There is nothing that has happened between then and today that has convinced me otherwise.

jj3044 wrote:Is it better than letting healthcare become 33% of our GDP by the time my kids are in college? Yes, I think so.

How do you know that it's better? If you don't know that it's better (and it seems like you don't), why would you spend $1.1 trillion?

jj3044 wrote:The funny part is that I hear a lot of complaints that the bill is going to cost 1.1T. But it has the potential to save a far greater sum of money to our country than that.

It has the potential? What, in our history, leads you to believe that something the government does will save money? You are putting a lot of faith in a government that has, among other things, waived the requirements of the ACA for going on 300 different (and large) companies and that, among other things, has helped to nearly bankrupt social security, and that, among other things, has helped to make sure Medicare and Medicaid are ineffective at best.

That is correct, I don't know that it will be better. All I know is that the current system is unsustainable and WOULD have bankrupted our country. I'm pretty sure we are all in agreement there. So, I'm willing to try it. I think that there are a lot of good provisions in the bill that will help reduce the cost of healthcare in the long run. Hopefully our government made a good decision.

Which good provisions in the bill will help reduce the cost of healthcare in the long run?Are you concerned about the assignment of waivers to various large employers?Are you concerned that the individual mandate will require that people purchase health insurance with generous benefits and virtually no cost-sharing? What provisions of the ACA require that premiums and costs of insurance remain static? In other words, what's to prevent all health insurance from doubling their prices?

I'm not sure if you read my older posts, but I illustrated many provisions that should reduce costs and improve outcomes. Instead of re-hashing the same post, feel free to search for them... I don't post too often so it shouldn't be hard.

As for waivers, my understanding is that those waivers are for a limited time only. I know that one company that I work with has a waiver, but that waiver expires in 2014 when they are forced to change their benefit design. That being the case, I am not worried as everyone will be on the same playing field. See, the waiver was needed for groups that wouldn't be able to afford coverage if they immediately got rid of their old designs (with lifetime limits, etc) that helped keep the cost lower for those groups. If their weren't any waivers, those groups would have been forced to drop coverage way before the healthcare exchanges were set up. The waiver allowed those companies to keep coverage until the exchanges were ready in 2014. At least, that is my understanding.

I'm not sure what you consider "generous benefits". Can you elaborate? The policies must have a minimum amount of coverage in order to be approved, but I'm not sure if that is what you are talking about here?

The ACA actually does have provisions to eliminate arbitrary rate increases. Insurers are now forced to spend at least $0.85 from every dollar on paying claims, so their overhead is limited to 15% or less. Also, I believe the ACA sets up regulators that will approve rate increase filings. They look at the financials and decide if the filing is appropriate. I happen to live in a state that their has been a health insurance commissioner for some time doing just that, so I have seen how it works. He often denies or reduces the proposed rate increases.

I did a search and there are actually too many to read. I trust that you've indicated the perceived benefits of the ACA.

(1) Waivers - You do not seem concerned. After a few minutes of searching, I cannot find anything tangible that indicates the waivers are temporary. I went on two supportive websites (Mother Jones and the SEIU website) and did not find anything there either. That's not to say I don't believe you, but the administrators of the ACA are not making it very clear that these are temporary, and that seems like a rather easy way to debunk conservative critiques. Kathleen Sebelius noted that "without the waivers, many employers would have increased premiums, and some would have dropped coverage altogether." A lobbyist for the AFL-CIO noted (in defense of his organization's waiver), that "some union health plans had a legitimate need for waivers because they had annual coverage limits lower than $750,000. If they had to increase coverage to that level they would incur significant new costs." These two statements seem to indicate that the ACA should not be implemented for all employees; just those employees of organizations which could afford the increased limits. That seems rather counterintuitive.

(2) Generous benefits - A simple example might be appropriate. Prior to the ACA, a health insurance plan cost $100 and provided potentially $200 of benefits. Subsequent to the ACA, a health insurance plan cost $120 and provided potential $500 of benefits. Does it concern you that the increase in benefits is not offset by an increase in cost?

(3) Rate increases - The law does not prevent rate increases. From the "healthcare.gov" website:

"For the first time ever in every State, insurance companies must publicly justify any rate increase of 10% or more. And the law gives States new resources to review and block these premium hikes."

I'm not sure how "public justification" of a rate increase helps. There can be a request or demand for public justification without a law. I make a demand for justification for price increases when I choose to purchase a cheaper pair of shoes. The market tends to take care of these things. Nevermind that the threshhold is 10% or more. This also seems like burden shifting by the government. Instead of the federal government assuming the burden of blocking premium hikes, it puts the onus on state governments. And, although some may call me paranoid, I'm not convinced that insurance companies don't have the wherewithal or political capital to block and attempts at blocking premium increases... especially at a state level.

I'm not suggesting that the ACA is a bad law. I don't know the answer. There are things about it that concern me (in addition to those listed above). To be honest, I would have preferred a state-run healthcare program than the ACA (although my most preferred plan would be to remove health insurance regulations completely and provide for increased competition). To be fair, as well, the ACA is essentially the Republican plan from the late 1990s and was implemented by a Republican governor in Massachusetts. Ultimately my concern is that this is a corporate boondoggle for health insurance companies that will merely pass more costs on to taxpayers. There is nothing that has happened between then and today that has convinced me otherwise.

Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.

jj3044 wrote:Is it better than letting healthcare become 33% of our GDP by the time my kids are in college? Yes, I think so.

How do you know that it's better? If you don't know that it's better (and it seems like you don't), why would you spend $1.1 trillion?

jj3044 wrote:The funny part is that I hear a lot of complaints that the bill is going to cost 1.1T. But it has the potential to save a far greater sum of money to our country than that.

It has the potential? What, in our history, leads you to believe that something the government does will save money? You are putting a lot of faith in a government that has, among other things, waived the requirements of the ACA for going on 300 different (and large) companies and that, among other things, has helped to nearly bankrupt social security, and that, among other things, has helped to make sure Medicare and Medicaid are ineffective at best.

That is correct, I don't know that it will be better. All I know is that the current system is unsustainable and WOULD have bankrupted our country. I'm pretty sure we are all in agreement there. So, I'm willing to try it. I think that there are a lot of good provisions in the bill that will help reduce the cost of healthcare in the long run. Hopefully our government made a good decision.

Which good provisions in the bill will help reduce the cost of healthcare in the long run?Are you concerned about the assignment of waivers to various large employers?Are you concerned that the individual mandate will require that people purchase health insurance with generous benefits and virtually no cost-sharing? What provisions of the ACA require that premiums and costs of insurance remain static? In other words, what's to prevent all health insurance from doubling their prices?

I'm not sure if you read my older posts, but I illustrated many provisions that should reduce costs and improve outcomes. Instead of re-hashing the same post, feel free to search for them... I don't post too often so it shouldn't be hard.

As for waivers, my understanding is that those waivers are for a limited time only. I know that one company that I work with has a waiver, but that waiver expires in 2014 when they are forced to change their benefit design. That being the case, I am not worried as everyone will be on the same playing field. See, the waiver was needed for groups that wouldn't be able to afford coverage if they immediately got rid of their old designs (with lifetime limits, etc) that helped keep the cost lower for those groups. If their weren't any waivers, those groups would have been forced to drop coverage way before the healthcare exchanges were set up. The waiver allowed those companies to keep coverage until the exchanges were ready in 2014. At least, that is my understanding.

I'm not sure what you consider "generous benefits". Can you elaborate? The policies must have a minimum amount of coverage in order to be approved, but I'm not sure if that is what you are talking about here?

The ACA actually does have provisions to eliminate arbitrary rate increases. Insurers are now forced to spend at least $0.85 from every dollar on paying claims, so their overhead is limited to 15% or less. Also, I believe the ACA sets up regulators that will approve rate increase filings. They look at the financials and decide if the filing is appropriate. I happen to live in a state that their has been a health insurance commissioner for some time doing just that, so I have seen how it works. He often denies or reduces the proposed rate increases.

I did a search and there are actually too many to read. I trust that you've indicated the perceived benefits of the ACA.

(1) Waivers - You do not seem concerned. After a few minutes of searching, I cannot find anything tangible that indicates the waivers are temporary. I went on two supportive websites (Mother Jones and the SEIU website) and did not find anything there either. That's not to say I don't believe you, but the administrators of the ACA are not making it very clear that these are temporary, and that seems like a rather easy way to debunk conservative critiques. Kathleen Sebelius noted that "without the waivers, many employers would have increased premiums, and some would have dropped coverage altogether." A lobbyist for the AFL-CIO noted (in defense of his organization's waiver), that "some union health plans had a legitimate need for waivers because they had annual coverage limits lower than $750,000. If they had to increase coverage to that level they would incur significant new costs." These two statements seem to indicate that the ACA should not be implemented for all employees; just those employees of organizations which could afford the increased limits. That seems rather counterintuitive.

(2) Generous benefits - A simple example might be appropriate. Prior to the ACA, a health insurance plan cost $100 and provided potentially $200 of benefits. Subsequent to the ACA, a health insurance plan cost $120 and provided potential $500 of benefits. Does it concern you that the increase in benefits is not offset by an increase in cost?

(3) Rate increases - The law does not prevent rate increases. From the "healthcare.gov" website:

"For the first time ever in every State, insurance companies must publicly justify any rate increase of 10% or more. And the law gives States new resources to review and block these premium hikes."

I'm not sure how "public justification" of a rate increase helps. There can be a request or demand for public justification without a law. I make a demand for justification for price increases when I choose to purchase a cheaper pair of shoes. The market tends to take care of these things. Nevermind that the threshhold is 10% or more. This also seems like burden shifting by the government. Instead of the federal government assuming the burden of blocking premium hikes, it puts the onus on state governments. And, although some may call me paranoid, I'm not convinced that insurance companies don't have the wherewithal or political capital to block and attempts at blocking premium increases... especially at a state level.

I'm not suggesting that the ACA is a bad law. I don't know the answer. There are things about it that concern me (in addition to those listed above). To be honest, I would have preferred a state-run healthcare program than the ACA (although my most preferred plan would be to remove health insurance regulations completely and provide for increased competition). To be fair, as well, the ACA is essentially the Republican plan from the late 1990s and was implemented by a Republican governor in Massachusetts. Ultimately my concern is that this is a corporate boondoggle for health insurance companies that will merely pass more costs on to taxpayers. There is nothing that has happened between then and today that has convinced me otherwise.

I agree player, I don't think it is perfect, but hopefully it will turnout better than what we had before.

So to respond Greekdog:1) I am getting my information from the attorney at my company. It's always possible that I am misunderstanding (they do seem to speak gibberish sometimes! ), but I know that the group I referenced in my previous post has an exemption that will expire in 2014, and they are going to be sending the part of their population that would be affected to the exchange.2)It doesn't worry me because there will be a good many healthy people who will now be paying for coverage (who didn't previous), so the actual costs will be spread out among a larger population.3) The law you mentioned, "And the law gives States new resources to review and block these premium hikes." is what I was talking about before, about how my state has a healthcare commissioner that reviews rate increases, and approves/modifies/denies them based on information that receive.

jj3044 wrote:2)It doesn't worry me because there will be a good many healthy people who will now be paying for coverage (who didn't previous), so the actual costs will be spread out among a larger population.

Or they can choose to pay the tax instead to save money and then force the insurance company to cover them when they do get sick since pre-existing conditions of all kinds can never be denied.

jj3044 wrote:hopefully it will turnout better than what we had before.

I honestly hope it will too, but I'm inherently skeptical about all things government. In my opinion, the government does things to benefit itself and its consituents (which are not people like you and me).

jj3044 wrote:1) I am getting my information from the attorney at my company. It's always possible that I am misunderstanding (they do seem to speak gibberish sometimes! ), but I know that the group I referenced in my previous post has an exemption that will expire in 2014, and they are going to be sending the part of their population that would be affected to the exchange.

Okay. That's one company I suppose. I'm not sure that removes my concerns, but perhaps you're not debating here.

jj3044 wrote:2)It doesn't worry me because there will be a good many healthy people who will now be paying for coverage (who didn't previous), so the actual costs will be spread out among a larger population.

Those people did pay for coverage in the past, they just didn't pay for their own coverage.

jj3044 wrote:3) The law you mentioned, "And the law gives States new resources to review and block these premium hikes." is what I was talking about before, about how my state has a healthcare commissioner that reviews rate increases, and approves/modifies/denies them based on information that receive.

Right. Again, not sure that removes my concerns, but perhaps you're not debating.

jj3044 wrote:hopefully it will turnout better than what we had before.

I honestly hope it will too, but I'm inherently skeptical about all things government. In my opinion, the government does things to benefit itself and its consituents (which are not people like you and me).

jj3044 wrote:1) I am getting my information from the attorney at my company. It's always possible that I am misunderstanding (they do seem to speak gibberish sometimes! ), but I know that the group I referenced in my previous post has an exemption that will expire in 2014, and they are going to be sending the part of their population that would be affected to the exchange.

Okay. That's one company I suppose. I'm not sure that removes my concerns, but perhaps you're not debating here.

jj3044 wrote:2)It doesn't worry me because there will be a good many healthy people who will now be paying for coverage (who didn't previous), so the actual costs will be spread out among a larger population.

Those people did pay for coverage in the past, they just didn't pay for their own coverage.

jj3044 wrote:3) The law you mentioned, "And the law gives States new resources to review and block these premium hikes." is what I was talking about before, about how my state has a healthcare commissioner that reviews rate increases, and approves/modifies/denies them based on information that receive.

Right. Again, not sure that removes my concerns, but perhaps you're not debating.

No, I'm not really debating with you, just letting you know what I have observed thus far working in the industry. I have absolutely no idea if it will pan out great, but I do think that the law is misunderstood, which is warranted based on the ambiguity that the law had when it was passed (as been pointed out since a lot of the congressmen who voted for it didn't read it). I agree that point is messed up, but once the provisions have been explained, I am so far not feeling all that bad about it.

The ACA and healthcare aside, I feel as though our society tends to have a self fulfilling prophecy though... if people think something will fail it typically does.

PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.

That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered. Most particularly, you have pretty much ignored or underplayed the impact of the previous condition exclusions and lifetime limit provisions. Those alone are responsible for placing thousands, if not millions on the government funded roles instead of private insurance.

At its root, there is something fundamentally, not sure if "immoral" is the correct word, but not quite good about a system in which more money is made when people are sicker.

Set aside the rest of the debate and just think about that for a minute. I am not talking about bad people, though of course such will take advantage of any system. (but ANY system... so sort of irrelevant to this part of the debate). I am talking about very good, very well meaning people.

One study we (more than one person, cannot remember the first poster) found earlier showed that orthopedic costs went up and the results went down when more orthopedists were in the same area. Orthopedics is a good example because while its important, its not life-threatening, and an area where there have been a lot of advances. What the study found was that when there are more doctors in an area, they will tend to treat patients sooner than if there were fewer doctors in the area.

Importantly, none of the doctors seemed to be aware they were doing this. It seemed to happen in a few different ways. One is just that doctors would talk to each other and sort of convince each other to do this or that more. When cases were more borderline, the tendency (unconscious tendency) was for the doctor to convince themselves to do the procedure, because unconsciously they knew that if they did not do it, another doctor might.

Anyway, a real fix will mean changing the way that system works.

It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).

PLAYER57832 wrote:This maybe should go in its own thread, but it is on topic.

At its root, there is something fundamentally, not sure if "immoral" is the correct word, but not quite good about a system in which more money is made when people are sicker.

Set aside the rest of the debate and just think about that for a minute. I am not talking about bad people, though of course such will take advantage of any system. (but ANY system... so sort of irrelevant to this part of the debate). I am talking about very good, very well meaning people.

One study we (more than one person, cannot remember the first poster) found earlier showed that orthopedic costs went up and the results went down when more orthopedists were in the same area. Orthopedics is a good example because while its important, its not life-threatening, and an area where there have been a lot of advances. What the study found was that when there are more doctors in an area, they will tend to treat patients sooner than if there were fewer doctors in the area.

Importantly, none of the doctors seemed to be aware they were doing this. It seemed to happen in a few different ways. One is just that doctors would talk to each other and sort of convince each other to do this or that more. When cases were more borderline, the tendency (unconscious tendency) was for the doctor to convince themselves to do the procedure, because unconsciously they knew that if they did not do it, another doctor might.

Anyway, a real fix will mean changing the way that system works.

It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).

This is an excellent point, and strides are currently being made in this area, as well. In some states, patient-centered medical homes are being created by insurers with pay-for-performance (better outcome) contracts. This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.

jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.

i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.

jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.

i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.

You can do that in a government controlled situation as well though. Doesnt just have to be free market incentives.

jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.

i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.

There will always be people that just don't care about their health and eat/drink themselves to death. It is the doctor's job to make sure that the proper treatment is available, and the proper resources are available to the patient however, and that is what improves with this model. Where before a patient was on their own to find a dietician to help them with nutrition for example, now the nutritionist works for the provider and the patient has access to them for a lower/no cost. We are trying to eliminate barriers for patients in this model as well as incent the doctors to follow up better and not waste resources.

PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.

That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered.

80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

jj3044 wrote:hopefully it will turnout better than what we had before.

I honestly hope it will too, but I'm inherently skeptical about all things government. In my opinion, the government does things to benefit itself and its consituents (which are not people like you and me).

jj3044 wrote:1) I am getting my information from the attorney at my company. It's always possible that I am misunderstanding (they do seem to speak gibberish sometimes! ), but I know that the group I referenced in my previous post has an exemption that will expire in 2014, and they are going to be sending the part of their population that would be affected to the exchange.

Okay. That's one company I suppose. I'm not sure that removes my concerns, but perhaps you're not debating here.

jj3044 wrote:2)It doesn't worry me because there will be a good many healthy people who will now be paying for coverage (who didn't previous), so the actual costs will be spread out among a larger population.

Those people did pay for coverage in the past, they just didn't pay for their own coverage.

jj3044 wrote:3) The law you mentioned, "And the law gives States new resources to review and block these premium hikes." is what I was talking about before, about how my state has a healthcare commissioner that reviews rate increases, and approves/modifies/denies them based on information that receive.

Right. Again, not sure that removes my concerns, but perhaps you're not debating.

No, I'm not really debating with you, just letting you know what I have observed thus far working in the industry. I have absolutely no idea if it will pan out great, but I do think that the law is misunderstood, which is warranted based on the ambiguity that the law had when it was passed (as been pointed out since a lot of the congressmen who voted for it didn't read it). I agree that point is messed up, but once the provisions have been explained, I am so far not feeling all that bad about it.

The ACA and healthcare aside, I feel as though our society tends to have a self fulfilling prophecy though... if people think something will fail it typically does.

I think most publicly-aired criticism is misplaced (i.e. criticism by conservative pundits and politicians). The supporters of the law and the detractors of the law do not seem to understand what it does or what it is meant to do.

PLAYER57832 wrote:Most particularly, you have pretty much ignored or underplayed the impact of the previous condition exclusions and lifetime limit provisions. Those alone are responsible for placing thousands, if not millions on the government funded roles instead of private insurance.

The only way I will believe that this is effective is if health care costs go down. There is, as of yet, no incentive associated with a decrease in health care costs.

PLAYER57832 wrote:It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).

Dollars are not the primary driver of medical care (or, at least, they are not supposed to be). The primary driver of medical care is to receive treatment such that you do not need to receive additional medical care. This is precisely why market economics should work in medicine. If I go to Doctor Smith and she doesn't solve my problem, I'm not going to go to Doctor Smith anymore. I'll go to Doctor Jones. Ultimatley, Doctors Smith and Jones are interested in treating and solving my problem, whether because they take their roles as doctors seriously or whether they would like to increase the size of their business.

In any event, the ACA will not solve this problem (if it is a problem) either. Keeping a patient on the books for financial reasons (which, honestly, I don't think doctors do for a variety of reasons) is not going to change if the patient now has better health insurance that will pay for more.

Congress did not read the yellow book before voting on it. Every single business owner will have to pay someone (actually, multiple people) to read every single page of the red tape stack AND interpret it AND enact it within their companies. And exactly 0 of those pages were ever voted on by our elected representatives or signed into law by the president, yet we will all be punished if we don't follow every single clause. Do people really think there is no harm to all these regulations?

PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.

That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered.

80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

Your facts are incredibly wrong. How on earth do you interprest that the increases will come from government spending? And how do you justify continually ignoring the real cost savings that are projected in the longer term?

PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.

That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered.

80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

Your facts are incredibly wrong. How on earth do you interprest that the increases will come from government spending? And how do you justify continually ignoring the real cost savings that are projected in the longer term?

OH... I get it, once again you care more about ideology than truth.

Funny what considering profit above everything else does.

In 2000, 13.1% of the population was uninsured (which means 86.9% were insured).In 2009, 16.3% of the population was uninsured (which means 83.7% were insured).In 2011, 15.3% of the population was uninsured (which means 84.3% were insured).

The Affordable Care Act insured approximately 3.6 million more people (raising the percentage from 83.7% to 84.3%).

Now, how much does the Affordable Care Act cost? The cost is constantly changing (I read yesterday that the estimated cost went up... I guess by changing I mean it always goes up). The Congressional Budget Office estimated that the ACA will cost more than $1.7 trillion in federal spending from 2012 to 2022; this cost is set to be offset by penalties and taxes, resulting in net spending of $1.2 trillion.

So, Night Strike's statistics are correct. And, once again, you have no statistics Player. So when you say "once again you care more about ideology than truth" are you talking about yourself? The ACA costs an incredible amount of money and insures 3.6 million more people. Either of those numbers could change, but how can you not be worried?

PLAYER57832 wrote:Most particularly, you have pretty much ignored or underplayed the impact of the previous condition exclusions and lifetime limit provisions. Those alone are responsible for placing thousands, if not millions on the government funded roles instead of private insurance.

The only way I will believe that this is effective is if health care costs go down. There is, as of yet, no incentive associated with a decrease in health care costs.

I see, so more people getting care is just of no consequence to you?

thegreekdog wrote:

PLAYER57832 wrote:It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).

Dollars are not the primary driver of medical care (or, at least, they are not supposed to be). The primary driver of medical care is to receive treatment such that you do not need to receive additional medical care. This is precisely why market economics should work in medicine. If I go to Doctor Smith and she doesn't solve my problem, I'm not going to go to Doctor Smith anymore. I'll go to Doctor Jones. Ultimatley, Doctors Smith and Jones are interested in treating and solving my problem, whether because they take their roles as doctors seriously or whether they would like to increase the size of their business.

No, for several reasons.

First, most people just don't have the option to just "choose another doctor", particularly in critical care, which is where the biggest cost issues are. You may not trust the local "hillbilly" doctor, but if your daughter breaks her leg or has an appendicitis attack or even is in a serious accident (heaven forbid of course) you rarely will be able to just choose whatever doctor you want.

The place where you theoretically can “make the choice” is in basic and preventative care. There, however, there are a few interesting twists.

Take one issue.. use of antibiotics. I hope you are aware that antibiotics are vastly over-used and that, as a result, we will be soon facing a world where there are no longer easy treatments for many diseases. (this IS the real situation, by-the-way…excepting only some magical new discovery akin to the transition from sulpha drugs to antibiotics earlier). So, why is this happening? Two fully market-driven reasons. First, antibiotics give animal producers a slight edge. These antibiotics permeate our world and expose more microbes to antibiotics, killing off many and leaving the more resistant ones behind. That this is happening is no longer even questionable, (unless you are expecting money from the meat industry and willing to thus ignore research) \.

Second, direct use.. doctors prescribe antibiotics to people who don’t need them because, as you say, if that doctor doesn’t give off the antibiotic, then some other doctor will… and the patient will likely not return. Many of these doctors know they are doing something incorrect, but feel they have no choice because they want to make a living. They will try to educate, but some people just won’t listen. [A third issue is not market-driven, per se.. its that people just don’t follow the doctor’s instructions to finish all their medication. As a result, instead of killing off “all” of the bacteria in the body, they leave a lot around.. those left naturally are those better able to resist the drug.. they reproduce and voila, we have more resistant bacterial strains flourishing. All three are significant, but you could even take out this last one and the impact would still be significant.]

A related example was given to you earlier.. that of orthopedics, where the more doctors you have in an area, the more surgeries/procedures and the lower the probability of success. I will refer you back to that discussion rather than reiterating it here, but the basic reason is that well meaning doctors find themselves very slightly making judgement calls more to do something than to not do something when other doctors are around. Partly its like above (not always conscious), that if this doctor doesn’t treat the patient, another doctor might. People are funny in that they too often think a doctor that “does something” is somehow “more willing to listen”, etc than one who just saying “go home and take 2 aspirin”. The other factor is that these doctors talk amongst themselves and wind up convincing each other that doing more work is truly necessary. Again, its not overt and intentional, but the impact is quite real… and dangerous.

I can give you example after example, but the bottom line is that medical care is not a traditional market-driven system. Add in that you have to actually know whether the results the doctor are giving you are or are not better…..and you have a real mess. I mean, there is a HUGE difference between a doctor who studies for years, has years of experience and someone making a few quick (or lengthy) internet searches to find the “better” answer. The internet is good at allowing people to find “answers” that are just plain dead wrong. On this level, this goes well beyond freedom of choice, because people tend to be very vulnerable and willing to listen to anyone who offers hope in many medical situations. It is, in fact, where the “optimism bias” comes seriously into play. The more serious the medical issue, the more vulnerable people can be… but the same thing happens for “lighter” issues as well.

The plain truth is that most people just are not equipped to nay say their doctor and to make truly informed decisions. They can decide they like or dislike the manner of the doctor, but when it comes to outcomes, it mostly involves trust… whether the outcome is good OR bad. Even knowing which happened can be a matter of trust (seriously… think about it. Can you “just tell” if your cancer was really cured… or if other problems were caused by the treatment, etc.?

thegreekdog wrote:In any event, the ACA will not solve this problem (if it is a problem) either. Keeping a patient on the books for financial reasons (which, honestly, I don't think doctors do for a variety of reasons) is not going to change if the patient now has better health insurance that will pay for more.

Lifetime limits? That IS ALREADY law. I am now able to get care, despite a lapse in insurance, because of the law. Before, my only real option was the PA fair pay plan, but only if I were lucky enough to be one of those enrolled… and that program is apparently on the chopping block.

The REAL solution is to have reasonable, science based limits on healthcare, NOT to leave it up to individual choice. People just don’t have enough information to do that. Insurance companies already do this to boost their profits, but any talk of doing that intentionally, in the open, in a government system subject to challenge gets shot down by conservatives shouting things like “death panels”.. Oh yeah, and your church is very much a part of that problem!

PS Or, to be more brief… The problem is that the first doctor might very well have been the better doctor, medically. It could be that your “problem” was not really a problem, that the risks of any potential solution actually outweigh any benefit (this is often the case with back/orthopedic issues, by-the-way) or that the doctor did have a real solution, but just not one you wanted to hear (maybe you need to lose weight instead of having knee surgery

You could argue that this is part of the system, customer care and all that. and yes, there is a push to train those factors more. Except, well, doctors are human. Doctors tend to get trained in medicine. Attorneys are the ones trained to argue convincingly.

Last edited by PLAYER57832 on Thu Mar 14, 2013 9:55 am, edited 1 time in total.

Night Strike wrote:Congress did not read the yellow book before voting on it. Every single business owner will have to pay someone (actually, multiple people) to read every single page of the red tape stack AND interpret it AND enact it within their companies. And exactly 0 of those pages were ever voted on by our elected representatives or signed into law by the president, yet we will all be punished if we don't follow every single clause. Do people really think there is no harm to all these regulations?

Night Strike wrote:Congress did not read the yellow book before voting on it. Every single business owner will have to pay someone (actually, multiple people) to read every single page of the red tape stack AND interpret it AND enact it within their companies. And exactly 0 of those pages were ever voted on by our elected representatives or signed into law by the president, yet we will all be punished if we don't follow every single clause. Do people really think there is no harm to all these regulations?

Your REAL "point" is that anything to do with government is "just bad". We get that.. now move on to specific examples where and exactly how it is bad.

See, most of also know that while not all regulation is good, not all is bad, either. Adding new regulation is not a universal fix, but neither is dismissing all regulation.

If you want to prove a real point, focus on specifics. Instead of "I hate Obamacare becuase it is Obamacare" (which, to be honest is pretty much your main point right now), how about exactly what you don't like, and what you would put in its place.

But oh.. stick to reality, not the fictions you can find so prevlently on the internet (and this thread)

warmonger1981 wrote:All I can say is once the foot is in the door it isn't long before most aspects of your health will be in review. Some people are naturally big not by there own doings. Is it fair to make them pay more if it is medically not their fault. Its a very slippery slope.

I agree this is an issue, but you do realize this has little to do with Obamacare? Insurance companies are driving this move already.

jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.

i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.